MEDICARE: COLLEEN FITZGERALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LGPC00087	DC
2	101YP2500X	Professional Counselor	LGP6561	MD

General Provider Information

NPI Number	:	1083146625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN FITZGERALD

Provider Business Mailing Address
First Line	:	5102 FLANDERS AVE
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1135
Country	:	US
Telephone Number	:	202-641-8113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2639 CONNECTICUT AVE NW
Second Line	:	SUITE 251
City	:	WASHINGTON
State	:	DC
Zip	:	20008-1537
Country	:	US
Telephone Number	:	202-681-4374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2017
Last Update Date	:	04/02/2017

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Directions to “ COLLEEN FITZGERALD ” Practice Location

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